Tuesday, June 8, 2010

You Kids Today and your Newfangled Contraptions

Being the news junkie that I am, I usually look forward to Tuesdays because that's when the New York Times does its Science and Health sections. Today was kind of a bust, but I did notice one piece about adopting electronic medical records systems. The basic gist of the piece is that the government is trying to push hospitals and doctor's offices to modernize and start using electronic medical records, in hopes of improving record-keeping and also record-sharing between professionals.

Predictably, there has been a lot of resistance to this, for a variety of reasons. Many medical professionals work in areas where there isn't a major hospital to connect with, or in areas where there aren't a ton of specialists. (Meanwhile, you can't swing a dead cat around the New York City area without hitting a specialist.) And frankly, switching over is expensive, which is frustrating when you have worked with EMRs and have realized that it's not very complicated code.

But that being said, a part of me wonders if all this controversy is really about a much more simple truth - old people don't like change. I've seen a lot of older doctors really struggle to figure out basic stuff like how to save their work, or how to look up labs. And I'm not saying it's easy, because EMR systems are user-unfriendly to say the least. But rather than taking a course to familiarize themselves, or just diving in to get used to it, they just write off the whole thing as useless and kvetch (while brandishing their canes?) about the good old days where you didn't have to document everything and the doctor's word was TRUSTED.

Now, it might just be me. But I'm really not the brightest crayon in the box, and I honestly can't remember what I've been told 10 minutes later, especially if I am tired or distracted. In an EMR system, you can continuously save and modify what you've written, and copy and paste data so that there's less human error. And considering how many cooks are messing with an individual patient's soup, I think it's helpful to have one program that everyone is using, which keeps track of who put what in the record. It creates a certain amount of accountability, because everyone's checking everyone else. I never really thought what I wrote as a 3rd year medical student mattered, but I've had nurses and residents come up to me a week later to ask about my plan of action for a given patient. (Usually they were scolding me, but looking back, it was nice knowing that I mattered a tiny bit.) It also makes it easier to figure out what a patient's story is in the broader sense, whether this is a patient who follows up on care and recommendations or not, or whether this is a patient with a history of drug-seeking behavior, or whether this is a patient whose care is so complex that he / she deserves to be specially discussed with your attending.

I can understand that the isolated doctor's office in Wichita, KS won't see the benefit of switching over for a long time, and it's not a terrific economy at the moment so this stuff will sting when you pay for it. And I'm not sure that EVERY hospital should be mandated to adopt the systems either. But I think the way to handle this is a little bit of carrot and stick. If I were the president (sounds like a 3rd grade essay...), I would mandate that all hospital systems with X number of patients or higher must adopt an EMR system that meets ABC criteria. This part could be a tiered system, such that every few years a new mandate kicks in for a slightly smaller hospital system, and smaller after that. This would give smaller systems time to save up for adopting an EMR, and also get to see them in action at larger institutions. In the meantime, entice the doctors local to those systems and give them a small bonus for also adopting. In this way, it would be good business for a doctor to use the same EMR, because it facilitates communication and referrals with the hospital system. Eventually you'd get a trickle-down effect, and increasingly rural areas would adopt the practice in keeping with standard of care.

On the other hand, I'm thinking of replacing my Palm Centro with a new HTC Incredible. And I'm pretty sure that when my battery dies after 30 min of use, I will be throwing it out the window and shaking my cane at it, too. Damn kids and their crazy apps.

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